Defining non-health professional responders in prehospital care as trained emergency healthcare workers – a strength-based approach

Dear Editor,

Throughout Australasia, clinicians who provide out-of-hospital care but are not registered as healthcare professionals do not have a collective title which accurately describes their role and instead are often classed as ‘non-healthcare professionals’ by large organisations, and within policy and research. Defining a group of clinicians by what they are not is a depreciative means of identifying a workforce. We propose a unifying strengths-based terminology for these clinicians to be used in research and practice.

Through our involvement with St John Ambulance in Australia, we have become interested in the unique position of health volunteers and paid staff who are not registered healthcare professionals, but provide significantly autonomous prehospital care. Despite a large amount of research from around the world which focuses on cardiac arrest care by these clinicians, there is a significant paucity in the broader literature describing their role, and a lack of a unifying descriptor, definition, or identifying title for this group of individuals, making further research difficult, and hampering their collective identity.^1,2

In the Australasian context, there are multiple terms used interchangeably across various jurisdictions. These include terms such as ‘first responder’, ‘community first responder’, ‘event medic’, ‘ambulance medic’, ‘volunteer ambulance officer’, ‘emergency medical technician’, ‘advanced responder’, ‘medic’, ‘emergency service officer’, etc. These terms all describe both volunteers and paid clinicians who are often highly trained but are not registered with the Australian Health Practitioner Regulation Agency (AHPRA) in Australia, or Te Kaunihera Manapou (New Zealand Paramedic Council), or another health professional regulation body established under the Health Practitioners Competence Assurance Act (HPCAA) in New Zealand.

Despite not being registered professionals, these clinicians provide clinical care with a high degree of independence and autonomy, often with significant personal investment of time and energy into developing their knowledge and skills over months to years. Failure to recognise this dedication has traditionally created division within many organisation's cultures.^3–5

It is for this very reason that we choose to describe those individuals often termed ‘community first responders’ or the myriad of other titles listed above as ‘Trained Emergency Healthcare Workers’ instead.

We find that even one of the most common terms, ‘community first responder’, does not appropriately delineate between the lay community member who spontaneously renders first aid, and the individual who has undergone extensive training to provide healthcare during emergencies in a planned or operationally deployed capacity. When we refer to the aforementioned individuals as ‘trained emergency healthcare workers’, we recognise the extensive vocational education they have undertaken, as distinct from formal tertiary study, to perform their roles. This framing emphasises the value of their work as labour, regardless of whether it is monetarily compensated. In the Australian context, volunteering in such a capacity meets the definition of providing labour. ⁶ We advocate for the use of this term to describe this group who identify with ideals of professionalism, and who perform labour (provide emergency healthcare) which requires skill, and is of significant importance to the community; and should be valued as such.

The adoption of this terminology is important because it will allow researchers to more effectively describe this group in the literature, and will enable these clinicians to collectively identify themselves, improving the ability to self-advocate. We strongly believe that trained emergency healthcare workers should be defined using a strengths-based approach ⁷ ; describing what they do, and who they are (and thereby recognising their value); not defining them as what they are not.